Abstract
There is significant variation internationally in ethical guidance on teaching and involvement of students in patient care. New Zealand is an outlier in requiring consent for teaching which "includes training" for all medical students and post graduate trainees. There is an ethical tension between the patient’s best interests to receive the best available care and the societal need to train new doctors. This tension is hard to resolve if the patient lacks capacity, and the decision is required to be made solely on the best interest of the patient. If this New Zealand standard is applied rigorously no-one would be able to learn a procedure that is only performed on a person lacking capacity. Requiring consent is not usual in the apprenticeship model which is central to the training of doctors. Any standards relating to managing the risks of teaching, and agreement for involvement in care must apply to all students and qualified doctors. Whilst patients retain the right to refuse treatment the value of having students as part of the team should be emphasised and the social norm should be that patients are involved in teaching. Teaching should be an ethical responsibility of all doctors. Particular guidance is needed for teaching/learning with patients who have limited or impaired capacity. This can be modelled on guidance developed for research on vulnerable patients.